Infectious Diseases I

Patient Cases (continued)

Questions 5 and 6 pertain to the following case.

F.P. is a 29-year-old man admitted to the MICU from another hospital with severe, alcohol-induced, sterile acute

pancreatitis. During his 5-day stay at the outside hospital, he had multiple organ failure, including respiratory

failure requiring tracheostomy. A right internal jugular CVC was placed on the patient’s admission to the outside

hospital. On MICU day 3, F.P. has a maximum temperature of 102°F (38.9°C). Two sets of blood cultures are

obtained; the right internal jugular catheter is removed and the tip sent for culture.

Which regimen would be best to consider for empiric management of a suspected CLABSI?

F.P. is found to have K. pneumoniae CLABSI and receives appropriate empiric antibiotic therapy. He has

had a good clinical response with no persistence of bacteremia. Which represents the best duration of F.P.’s

definitive antibiotic therapy for CLABSI?

chapter.

Although clinical signs and symptoms are the mainstay for differentiating CAUTIs from catheter-

associated asymptomatic bacteruria, they are not specific for CAUTI. These include fever, rigors, altered

mental status, malaise, or lethargy with no other identified cause. Presence of flank pain, costovertebral

angle tenderness, acute hematuria, and pelvic discomfort may be more specific, but these are difficult

to assess in many critically ill patients.

Sampling should be done through the catheter port using aseptic technique. Catheters in place for

longer than 2 weeks should be replaced and a urine sample obtained from the port of the newly placed

catheter. Samples from the catheter collection system (e.g., catheter bag) should be avoided because of

the potential for colonization.

Urinalysis should be obtained in patients with a suspected CAUTI. Pyuria without signs and symptoms

does not indicate CAUTI; however, the absence of pyuria in a symptomatic patient suggests a diagnosis

other than CAUTI.